• Journal of Chest Surgery
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• v.37 no.7
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• pp.601-605
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• 2004

Addisonian crisis, also commonly referred to as adrenal crisis, occurs when the cortisol produced by the adrenal gland is insufficient to meet the body's needs. Pituitary apoplexy usually occurs as hemorrhagic and ischemic necrosis in the presence of a pre-existing pituitary adenoma, and is a rare sequela of cardiovascular surgery. Most pituitary apoplexy that happens in cardiovascular surgery has been known to be related to harmful effects of the cardiopulmonary bypass. The case presented herein illustrates occult pituitary apoplexy that occurred after off-pump coronary artery bypass grafting. In this patient, . the initial signs of addisonian crisis was similar to those of septic shock, and were overlooked. However, once recognized, they were reduced dramatically with standard stress-dose cortisone.

• Kosin Medical Journal
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• v.33 no.2
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• pp.215-222
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• 2018

An incidentaloma is a tumor found incidentally without clinical symptoms or suspicion; the lesion may be adrenal, pituitary, or thyroidal. We report the case of an asymptomatic individual with preoperatively undiagnosed pheochromocytoma (size: 4.86 cm) that was revealed using elective nonadrenal surgical procedures. The patient demonstrated peri- and post-operative hypertensive crisis and tachycardia. Three days after the dramatic onset of symptoms, the patient expired due to pulmonary edema, multiple organ failure, and terminal sepsis, despite administration of extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation. A left medial kidney mass obtained at autopsy confirmed pheochromocytoma.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.70-73
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• 2019

Congenital panhypopituitarism is an uncommon condition, present from birth, characterized by the decreased secretion of most of the hormones produced by the pituitary. The purpose of this case report is to present a case about caries treatment of a 26-month-old female patient with congenital panhypopituitarism under general anesthesia. A 26-month-old girl with congenital panhypopituitarism visited Seoul National University Dental Hospital for caries treatment of anterior primary teeth. Because of the child's age and underlying systemic disease, dental treatment under general anesthesia was considered. Prior to the dental procedure, 30mg of cortisol was administered intravenously in order to prevent possible adrenal crisis by stressful events. The dental procedure was successfully performed under general anesthesia. This case report suggests that general anesthesia may be useful for the dental treatment with congenital panhypopituitarism. Hormone deficiency should be assessed prior to dental procedure and, if necessary, stress hormone replacement therapy should be considered.

• Journal of Veterinary Clinics
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• v.22 no.2
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• pp.130-135
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• 2005

A retrospective study was performed with 9 cases of spontaneous canine hypoadrenocorticism presented to the Veterinary Medical Teaching Hospital of Seoul National University. The disease occurred mostly in young to middle­aged dogs. Most dogs had chronic nonspecific signs such as episodic anorexia, lethargy and vomiting, but 3 dogs were brought to the hospital with an acute adrenal crisis. Serum biochemical analysis revealed azotemia, abnormal concentration of sodium, potassium, and chloride in almost all the patients. Diagnoses were made based on lack of adrenocortical response to exogenous adrenocorticotropic hormone(ACTH). Most dogs have been responded well with mineralocorticoid and glucocorticoid replacement except for a dog which died during treatment for adrenal crisis. Three dogs treated with fludrocortisone acetate(final median dosage, $31.0{\mu}g/kg/day$) for mineralocorticoid supplementation showed some adverse effects, such as excessive appetite and polyuria/polydipsia. In this study, it was suggested that clinicians should also consider hypoadrenocorticism when they diagnose a patient showing nonspecific gastrointestinal signs with unknown cause or laboratory findings which mimic primary renal diseases.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.2
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• pp.70-78
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• 2016

21-hydroxylase deficiency (21-OHD), most common form of congenial adrenal hyperplasia, is categorized into classical forms, including the salt-wasting (SW) and the simple virilizing (SV) types, and nonclassical (NC) forms based on the severity of the disease. Newborn screening for 21-OHD has been performed in Korea since 2006. $17{\alpha}$-hydroxyprogesterone (17-OHP) is a marker for 21-OHD and is measured using a radioimmunoassay or a fluoroimmunoassay. Premature and low birth weight infants are likely to give false positive 17-OHP findings, therefore, cutoff values for these infants should be determined based on gestational weeks or birth weight. ACTH simulation test is helpful when the 17-OHP shows equivocal increase, and it is gold standard for diagnosis of NC type. Recently, liquid chromatography linked with tandem mass spectrometry was developed for rapid, highly specific, and sensitive analysis of multiple analytes. Molecular analysis of CYP21A2 is useful for confirming diagnosis of mild SV or NC type, predicting prognoses, and genetic counseling. In order to make newborn screening for 21-OHD more efficient, early detection of boy with SW type, early determination of girl with ambiguous genitalia, detection of NC type, and overcoming of false positive in premature and low birth weight infants should be considered. Above all, early treatment should be started when the patient is suspected as having 21- OHD clinically before confirming the diagnosis to prevent adrenal crisis. Here, author reviewed recent articles of guideline and proposed guideline for 21-OHD.

• Journal of Veterinary Clinics
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• v.22 no.4
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• pp.450-452
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• 2005

A 3-year-old, 43kg, pregnant Great Pyrenese was examined for clinical signs of acute weakness and anorexia for 4 days. The dog was in lateral recumbency at referral. The rectal temperature was within reference range, and the respiratory and heart rates were 36 breaths/min and 58 beats/min, respectively. The abdomen was distended, and several puppies were palpated. The mean fetal head diameter was 2.8cm in the ultrasonographic examination. The initial complete blood count and serum biochemical examinations revealed mild dehydration, mud hyperglycemia, hypochloremia, hyperkalemia, hyponatremia, and low sodium-potassium ratio. Serum BUN and total cholesterol values were slightly high. Hypoadrenocortical crisis was suspected on the basis of signs of acute collapse, hyponatremia and hyperkalemia. Adrenal gland function was evaluated by an ACTH stimulation test. The baseline cortisol concentration was $18.6{\mu}g/dl$ and the concentration at 1 hour after administration of tetracosactrin (ACTH, Synacthen) was $8{\mu}g/dl$. The dog was treated for the correction of assumed hypoadrenocortical crisis and substantial hyperkalemia. In addition to rapid infusion with saline solution, other medications administered intravenously included sodium bicarbonate and cimetidine hydrochloride. The dog was monitored with repeated serum electrolyte examination. After clinical stabilization, cesarean section was performed. All of 13 puppies were delivered, and the dog recovered from anesthesia without complications. The values of postpartum blood tests returned to normal or within reference range. The dog remained healthily.